Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study

Edvardsson, Kristina; Ntaganira, Joseph; Åhman, Annika; Sengoma, Jean Paul Semasaka; Small, Rhonda; Mogren, Ingrid

doi:10.1111/tmi.12718

Cited by 26 publications

(61 citation statements)

References 34 publications

(48 reference statements)

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“…The provision of obstetric PoCUS courses and the resultant health providers capable of performing basic scans has made a significant impact on the accessibility of ultrasound to women in remote regions. This statement is supported by literature from Kenya, Libya, Rwanda, Tanzania, Uganda and Zambia . Vinayak et al .…”

Section: Discussionsupporting

confidence: 78%

Comparing the effectiveness of training course formats for point‐of‐care ultrasound in the third trimester of pregnancy

Westerway

2019

Australas J Ultrason Med

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Introduction: The availability of obstetric point-of-care ultrasound (PoCUS) services has been shown to improve pregnancy outcomes in regional and remote areas both in Australia and around the world. There is an increasing demand for efficient, costeffective PoCUS courses for monitoring the fetus in the third trimester of pregnancy. Aim: To compare the effectiveness of targeted PoCUS courses provided for health professionals that assess the fetus during the third trimester of pregnancy. Method: The skill-teaching curriculum and competency outcomes of six obstetric PoCUS courses were compared. There were 55 learners with no prior ultrasound experience including 23 with English as a second language. Course duration ranged from 4 to 18 h, didactic lecture time up to 6 h and practical scanning sessions of 3-12 h. Learner/tutor ratio varied from 1:1 to 6:1. All courses included the teaching of knobology, image optimisation and probe manipulation. Practical sessions included supervised scanning of ultrasound phantoms and scanning women in the third trimester of pregnancy. The teaching outcomes that were assessed included image optimisation, determination of fetal lie, fetal heart rate, measuring the single deepest pocket of amniotic fluid, identifying the placental position and basic fetal biometry. The same pre-and post-course multiple choice test and course evaluation forms were used for every programme. Results: All participants achieved the limited course objectives, regardless of the differences in the course formats. Conclusion: This study confirms that obstetric PoCUS courses can provide the initial basic knowledge and scanning skills required to perform limited scope third-trimester scanning.

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Section: Discussionsupporting

confidence: 78%

Comparing the effectiveness of training course formats for point‐of‐care ultrasound in the third trimester of pregnancy

Westerway

2019

Australas J Ultrason Med

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“…The study questionnaire was developed based on the results from the earlier qualitative studies performed in the CROCUS study 7 19–27. Sociodemographic characteristics, evaluation of self-reported skills in performing ultrasound, and questions about access to obstetric ultrasound and health professionals’ views on what may improve utilisation of ultrasound in Vietnam were included, among other items.…”

Section: Methodsmentioning

confidence: 99%

Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study

et al. 2019

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ObjectivesObstetric ultrasound is an important part of antenatal care in Vietnam, although there are great differences in access to antenatal care and ultrasound services across the country. The aim of this study was to explore Vietnamese health professionals’ experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.DesignA cross-sectional questionnaire study was performed as part of the CROss Country UltraSound study.SettingHealth facilities (n=29) in urban, semiurban and rural areas of Hanoi region in Vietnam.ParticipantsParticipants were 289 obstetricians/gynaecologists and 535 midwives.ResultsA majority (88%) of participants agreed that ‘every woman should undergo ultrasound examination’ during pregnancy to determine gestational age. Participants reported an average of six ultrasound examinations as medically indicated during an uncomplicated pregnancy. Access to ultrasound at participants’ workplaces was reported as always available regardless of health facility level. Most participants performing ultrasound reported high-level skills for fetal heart rate examination (70%), whereas few (23%) reported being skilled in examination of the anatomy of the fetal heart. Insufficient ultrasound training leading to suboptimal pregnancy management was reported by 37% of all participants. ‘Better quality of ultrasound machines’, ‘more physicians trained in ultrasound’ and ‘more training for health professionals currently performing ultrasound’ were reported as ways to improve the utilisation of ultrasound.ConclusionsObstetric ultrasound is used as an integral part of antenatal care at all selected health facility levels in the region of Hanoi, and access was reported as high. However, reports of insufficient ultrasound training resulting in suboptimal pregnancy management indicate a need for additional training of ultrasound operators to improve utilisation of ultrasound.

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“…In one of the previous studies undertaken by the CROCUS research group, it was identified that no physicians were permanently posted at health centres and physicians managing pregnant women in district hospitals were mainly general practitioners. Obstetric ultrasound scans are generally provided at district and referral hospitals, but also at private clinics [35]. Only physicians are formally approved to perform ultrasound examinations and the majority of physicians have no or limited formal training in ultrasound surveillance during pregnancy [35].…”

Section: Introductionmentioning

confidence: 99%

“…Obstetric ultrasound scans are generally provided at district and referral hospitals, but also at private clinics [35]. Only physicians are formally approved to perform ultrasound examinations and the majority of physicians have no or limited formal training in ultrasound surveillance during pregnancy [35]. The Ministry of Health in Rwanda has issued guidelines for clinical management in gynaecology and obstetrics [36], but specific guidelines for the use of obstetric ultrasound are limited.…”

Section: Introductionmentioning

confidence: 99%

Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives’ experiences and views of obstetric ultrasound

Holmlund

Ntaganira

Edvardsson

et al. 2017

Global Health Action

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Background: Obstetric ultrasound has become an indispensable part of antenatal care worldwide. Although the use of ultrasound has shown benefits in the reduction of maternal and foetal morbidity and mortality, it has also raised many ethical challenges. Because of insufficient numbers of midwives in Rwanda, uncomplicated pregnancy care is usually provided by nurses in local health centres. Obstetric ultrasound is generally performed by physicians at higher levels of healthcare, where midwives are also more likely to be employed. Objectives: To explore Rwandan midwives’ experiences and views of the role of obstetric ultrasound in relation to clinical management, including ethical aspects. Methods: A qualitative study design was employed. Six focus group discussions were held in 2015 with 23 midwives working in maternity care in rural and urban areas of Rwanda, as part of the CROss Country Ultrasound Study (CROCUS). Results: Obstetric ultrasound was experienced as playing a very important role in clinical management of pregnant women, but participants emphasised that it should not overshadow other clinical examinations. The unequal distribution of ultrasound services throughout Rwanda was considered a challenge, and access was described as low, especially in rural areas. To increase the quality of maternity care, some advocated strongly for midwives to be trained in ultrasound and for physicians to receive additional training. In general, pregnant women were perceived both as requesting more ultrasound examinations than they received, and as not being satisfied with an antenatal consultation if ultrasound was not performed. Conclusions: Obstetric ultrasound plays a significant role in maternity care in Rwanda. Increasing demand for ultrasound examinations from pregnant women needs to be balanced with medical indication and health benefits. Training of midwives to perform obstetric ultrasound and further training for physicians would help to address access to ultrasound for greater numbers of women across Rwanda. RESPONSIBLE EDITOR Virgilio Mariano Salazar Torres, Karolinska Institute, Sweden

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Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study

Cited by 26 publications

References 34 publications

Comparing the effectiveness of training course formats for point‐of‐care ultrasound in the third trimester of pregnancy

Comparing the effectiveness of training course formats for point‐of‐care ultrasound in the third trimester of pregnancy

Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study

Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives’ experiences and views of obstetric ultrasound

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